Vaginal birth after caesarean section: a practical evidence-based approach

In the UK, around 10–15% of the obstetric population have experienced prior caesarean delivery. This article provides a practical evidence-based approach to the antenatal and intrapartum management of such women. This review is primarily sourced from data presented in guidelines produced by UK (RCOG, NICE) and USA (ACOG, NIH) professional bodies. Antenatal counselling should incorporate an individualized assessment of the risks and benefits of ERCS (elective repeat caesarean section) and planned VBAC (vaginal birth after caesarean) modes of delivery. Planned VBAC is associated with slightly (0.25%) increased perinatal risk than planned ERCS, although absolute risks are low for both modes of delivery. This information, coupled with high rates of VBAC success (70%) and very low-risk of uterine scar rupture (0.5%), indicates planned VBAC is an appropriate option for the vast majority of multiparous women with previous caesarean delivery and is cost effective for the healthcare provider. Of significance, recent guidance from NICE (UK) adds a further dimension to decision making as it has stated that maternal request for caesarean section is permissible in certain circumstances.